No Scales, No BonesDemanding Better Representation of Eating Disorders

Thirty million people in the United States will develop a clinically significant eating disorder in their lifetime. That’s over 10 percent of the population. And yet, no matter how excited I—as a survivor and recovery advocate—get for newly released media on the topic of eating disorders, I almost always find myself disappointed after engaging with it. From movies portraying thin, white women with anorexia nervosa (another one?) to educational articles with triggering content, media that explores eating disorders often does so narrowly—and sometimes even offensively.

It is imperative that we continue publishing literature and producing visual media that raises awareness about eating disorders, but it’s long past time for us to get it right. So, in celebration of National Eating Disorders Awareness Week, here are four ways I’d like to see these complex illnesses represented differently.

1. Diversify the Protagonist

The common myth about eating disorders is that they only affect thin, white, middle-to-upper-class women. Because, throughout history, this group has been at the center of inquiry into the illnesses (from starving saints in the 16th century to fasting girls in the Victorian age and beyond), they’ve been solidified in the minds of many as the population chiefly affected. This myth is perpetuated by contemporary published research on eating disorders, which often samples participants from treatment centers—a method that’s easier for the researcher (a gold mine of participants who meet criteria!), but limited to people who have access to top-notch healthcare.

Yet, most people with eating disorders are unable to access treatment. This is due to faulty insurance that often doesn’t cover eating disorders, and the high cost of treatment. Facilities charge an average of $1000 per day. So when will media stop only promoting stories that take place in treatment facilities with protagonists who are thin, white, and middle-to-upper class?

The truth is, eating disorders are prevalent across racial and ethnic backgrounds, with the possible exception of anorexia nervosa, which is more commonly diagnosed in white people. The stereotype that eating disorders more commonly affect people with higher socioeconomic status has yet to be empirically proven; in fact, evidence shows the opposite relationship in regards to bulimia nervosa. Fat stigma, including socially accepted health policies regarding the “obesity epidemic,” can play into how fat people develop eating disorders and are treated for them. And eating disorders don’t only affect cisgender women: These illnesses are on the rise for men, and trans youth are more likely to engage in compensatory behavior than any other group. There is no reason why stories about eating disorders can’t focus on people outside of the most privileged group—and we’re doing direct harm to sufferers and survivors who never see themselves represented.

2. Rethink the Images

I love to share resources about eating disorder recovery on social media. Frequently, brilliant articles are published that address body image, eating disorders, and fat politics. However, I consistently run into the same problem as I hover over the “retweet” button: The images that most media outlets use to represent eating disorders are (1) representative of the problem stated above and (2) triggering. I can’t repost sensationalized pictures of thin, white women hovering over bathroom scales with visibly protruding bones into the social-media feeds of my vulnerable audience because they reinforce harmful myths about eating disorders.

In June 2018, SELF magazine released “The Weight Issue,” a series of articles that explained why “wellness is for everyone” regardless of weight. Editor-in-chief Carolyn Kylstra created a style guide for health brands that want to talk about weight, which stressed the importance of visual representation and included recommendations for the kinds of images to use and how these stories should be packaged. Although the series focused specifically on combating fat stigma in health reporting, many of the recommendations apply to reporting about eating disorders as well:

Images and image collections should be diverse and inclusive.

Avoid editing photos to change the size or shape of a person’s body, or to remove cellulite or stretch marks.

Avoid publishing before-and-after weight loss pictures.

Avoid graphic pictures of the bodies of people in the midst of an eating disorder.

This issue isn’t only about representation (although that’s surely reason enough to change practices); it’s also an issue of responsibility. If your content on an illness has the potential to harm those with that illness, it’s not appropriate.

Media to Support: During my five-year stint as Managing Editor of Everyday Feminism, my team and I did our best to influence common imagery practices, with the amazing help of our audience.

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3. Avoid Blatantly Triggering Material

The word “trigger” has a specific meaning, no matter who’s using it: “A trigger is something that sets off a memory tape or flashback transporting the person back to the event of [their] original trauma,” according to the University of Alberta’s sexual assault centre. Triggers push people back into a mindset supported by their mental illness, which is the reason the word is most often used to describe experiences with PTSD. Being triggered does not simply mean that someone is uncomfortable with or angered by content, despite what the anti-trigger-warning crusade wants you to believe. Being triggered can have devastating consequences, including prompting eating disorder thoughts and behaviors.

Though anything can technically be a trigger (the color red, for instance, could be associated with trauma) and it’s impossible to cover all of those bases, there is language or narration that is more likely triggering and should be avoided in stories about eating disorders. The most potentially triggering material is the most graphic, including imagery of severe thinness; numbers associated with weight, calories, etc., especially those that are extreme; and detailed depictions of behavior. Of course, this content can serve a purpose: When trying to raise awareness about mental illness, it can feel necessary to describe its symptoms. But this content too easily veers into the lane of exploitation, especially when asking content creators to revisit their trauma.

The National Eating Disorders Association has published a helpful guide for sharing your story publicly in a responsible way. In it, they include ways for creators to prioritize their well-being and avoid stereotypes in storytelling. They also suggest you “try not to inadvertently glamorize [eating disorders] or promote copycats who may experiment with life-threatening behaviors.”

Some examples that they provide include:

Don’t focus on graphic images or physical descriptions of the body at its unhealthiest point.

Don’t provide “tips” or play the numbers game.

Watch out for the appearance ideal.

Emphasize the seriousness of eating disorders without portraying them as hopeless.

Platforms producing content on eating disorders should familiarize themselves with these guidelines and ask creators to follow them.

4. Represent Binge Eating Disorder and Weight Gain

In 2013, the fifth update of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders(DSM) finally included binge eating disorder (BED) as a disorder in and of itself (previously, it had been listed as a subtype). This is important for insurance-related issues: You can’t receive treatment for a disorder that doesn’t exist in the literature. But it’s also important for representation: You can’t recognize an illness in yourself if you’ve never heard of it. However, media has yet to catch up on reporting and storytelling about this common but highly misunderstood disorder.

In a culture obsessed with purity and control, including in relation to food, it’s unsurprising that anorexia nervosa is the eating disorder that we most often see represented in media.

In a culture obsessed with purity and control, including in relation to food, it’s unsurprising that anorexia nervosa is the eating disorder that we most often see represented in media. As a society, we hold a gauzy, romanticized vision of the illness; it is, after all, diet culture’s logical conclusion. Associated with refusal and abstinence, there’s little to see with anorexia; bulimia, on the other hand, is considered messy—less serene. Binge eating disorder, which shares much of bulimia’s diagnostic criteria, minus consistent compensatory behavior, is seen similarly: These disorders represent a lack of control.

Binge eating disorder is also associated with fat people. Of course, eating disorders and body size have next-to-no relationship (outside of controversial anorexia diagnostic criteria that include being underweight). But two-thirds of people diagnosed with binge eating disorder are labeled “clinically obese” (a term that we should do away with). Because BED is associated with stretches of restriction (dieting), followed by compulsive eating (your body’s response to restriction), a back-and-forth known as yo-yo dieting, many people with BED experience weight cycling overweight loss followed by weight gain. The experience of weight gain in people with eating disorders should be better represented in media.

Melissa A. Fabello is a feminist writer who covers issues related to body politics and beauty culture. Her activism focuses on making peace in eating disorder recovery, striving toward eliminating size stigma, and bringing a more radical lens to the mainstream body positivity conversation. You can learn more about Melissa (and sign up for her newsletter) on her website. Follow her on Twitter and Instagram @fyeahmfabello.